Ontario shelves electronic registry of joint surgery data

The Ontario government has sparked outrage among orthopedic health-care providers by announcing plans to shut down an electronic system that collects data to improve and reduce wait times for hip and joint replacement surgeries.

Representatives from the Canadian Arthritis Society on Wednesday called on the Ministry of Health and Long-Term Care to reverse the decision, which they said would waste an online database that has been widely accepted and embraced by health-care practitioners across the province. Originally developed five years ago, the Ontario Joint Replacement Registry (OJRR) manages information on more than 60,000 patients from nearly 200 orthopedic surgeons in 56 hospitals.

The OJRR was originally designed to collect best practice information about surgeries to improve patient outcome by reducing the number of “revisions,” or follow-up procedures, which tend to be more expensive to the health-care system and carry an increased risk of complications. Over time, however, it has also tracked information on the wait time from the decision to have surgery to the time the surgery occurs.

According to Jo-Anne Sobie, president of the Arthritis Society’s Ontario division, the Ministry has decided that data will be better managed in a new registry that will focus on overall wait times in the health-care system. “They have not developed it yet, but they’ve said it will be up and running by the end of the year. I’m not confident that will happen,” she said.

A Ministry of Health spokesman disagreed with the Arthritis Society’s interpretation of its plans, describing it as an effort to integrate the OJRR into the wait time management system.

“We certainly recognize the good work those in the OHS have done to produce the registry to this point,” he said. “We’re not just dropping this in favour of our own system.”

Bob Bourne, a doctor at London Health Sciences Centre and the OJRR’s executive director, said he received a memo from the Ministry at the end of April that the OJRR would be cancelled in March 2006. Neither he nor his team were consulted on the decision, he said.

“I think they are hoping to develop their own access-to-care IT platform, such that each hospital, at least for the five priority areas for now, will monitor how many people are waiting, and maximal wait times,” he said. “Our concern is that we encourage increased access to care, but you cannot forget the quality piece.”

Since January of this year, every patient undergoing joint replacement at hospitals such as Toronto-based Sunnybrook and Women’s Health receives a consent form and an information package about the OJRR. Patients are asked to complete a questionnaire that determines their level of disability based on The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The WOMAC is a widely used measure of symptoms and disability related to arthritis and evaluates three dimensions: pain, stiffness and physical function.

The data collected pertains to three key areas: waiting times to see an orthopedic surgeon for an initial consultation, waiting times from consultation to the actual surgery and surgical data. Information is then exchanged with the OJRR through two separate Web-based submissions: an initial summary and a surgical report.

The OJRR has been an early proponent of handheld technology, providing Compaq iPaq Pocket PCs to 175 orthopedic surgeons, who used them with barcode scanners during surgery to log the model number and lot numbers of replacement joints used. Data from this pilot project played a part in the provincial government’s decision to fund 3,000 more joint replacements per year, from 19,000 to 22,000. In its most recent newsletter two months ago, however, the OJRR said it recognized surgeons were switching from handhelds to its secure Web site for data entry and submission, and was upgrading the site to make it easier to do so.

A Canadian joint replacement registry exists, but it’s a paper-based system whose information is usually two days out of date, Bourne said.  

“If you’re trying to identify an implant with a problem, you’re dealing with many tens of thousands of patients. It really doesn’t work as a surveillance mechanism that way,” he said. “To have the plug pulled (on the OJRR) at this time is a big concern to us. We’re trying to find some middle ground here, but it’s been an uphill climb.”

Sobie agreed, adding that the Ministry’s decision has sent a shock wave throughout the profession.

“They built something absolutely wonderful and we’re asking the government to continue to build on what’s there,” she said. “We’ve going from a state of the art solution to a 1970s solution.”

The Ministry has said its wait time strategy will create a system  that monitors and manages wait times, improves how efficiently and effectively care is  delivered and makes wait time information available to the public and providers. Its five key areas include cancer surgery, selected  cardiac procedures, cataract surgery, hip and knee total joint replacements and MRI/CT  scans.

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